Abstract

Introduction: Delay in the clearance of circulating triglyceride (TG)-rich lipoproteins from circulation following the consumption of fatty foods is reportedly atherogenic. The literature on the risk of incident cardiovascular events attributed to postprandial lipemia (PPL) is inconclusive, however.

Objective: To quantify the degree to which PPL is associated with incident coronary heart disease (CHD) and stroke in Caucasians and African Americans.

Methods: Members of the community-based ARIC cohort (n=559) who were free of manifest cardiovascular disease in 1990-1993 (visit 2) participated in a substudy during visit 2 comparing PPL in cases of subclinical atherosclerosis versus controls free of carotid artery atherosclerosis. Postprandial TG, TG-rich lipoprotein triglycerides (TRL-TG), retinyl palmitate (RP), and apolipoprotein B48 to apolipoprotein B100 ratio (apoBR) concentrations were measured from blood samples collected at 0 (fasting), 3.5 and 8 hours after consumption of a fatty meal. The area under the curve (AUC) of the lipid value versus time was calculated for each PPL measure and transformed into weighted standard deviation units. Crude, age-sex adjusted, and fully adjusted associations of risk for validated incident CHD and stroke events (as individual and merged outcomes) by 2013 attributed to each AUC variable were estimated using Cox proportional hazard regression. For fully adjusted models, a stepwise method was applied to select from the following visit 2 covariates: race (Caucasian vs. African American), body mass index (BMI), carotid intima media (IMT), hypertension status, low and high density lipoprotein cholesterols, and cigarette smoking status. Additionally, individual associations of TG, TRL-TG, RP, and apoBR with incident events were evaluated by race and for categories of BMI and IMT.

Results: Of 559 individuals without manifest cardiovascular disease in 1990-1993 (visit 2), 127 (23%) developed CHD and 27 (5%) experienced a stroke by 2013. None of the PPL parameters measured at visit 2 were associated (p>0.05) with incident CHD or stroke by 2013 in crude, age-sex adjusted, or fully adjusted models. Similarly, stratified analyses did not identify significant associations between any of the PPL measures and incident events across race, BMI, or IMT subgroups.

Conclusion: Extended follow up of a well-characterized, population-based cohort indicates that the extent of postprandial lipemia is not associated with risk of coronary heart disease or stroke.